Abstract

Volume.122 Number.3

Antiproliferative Trabeculectomy: from its Birth to its Retirement
Tetsuya Yamamoto
Department of Ophthalmology, Gifu University Graduate School of Medicine

Surgery is needed to prevent blindness in many glaucoma cases. The present paper recounts the history of glaucoma filtering surgery, followed by a discussion of the development of trabeculectomy with adjunct mitomycin C (hereinafter "MMC-Trab"), including current outcomes of this surgery based on data spanning a period of 10-25 years. Predictions for the near future of glaucoma surgery are also presented.
The first filtering surgery was performed as far back as the 19th century. Modern filtering surgery owes its development to the introduction of the scleral flap and establishment of MMC-Trab. This paper discusses the results of research into MMC-Trab conducted at institutions including the Gifu University Department of Ophthalmology and presents new outcomes of MMC-Trab in terms of intraocular pressure (IOP), visual function, and blindness prevention using data on cases managed by the Gifu University Department of Ophthalmology. A particular focus is placed on postoperative outcomes of cases of low preoperative IOP. MMC-Trab currently occupies an important position in our approach to glaucoma treatment.
MMC-Trab is the first treatment modality to allow adequate lowering of IOP to be achieved over the long term. This means that MMC-Trab can be regarded as a magnificent experimental system in glaucoma etiology. This raises the possibility of finding clinical answers to the thesis that "the progression of glaucoma could be stopped by sufficiently lowering IOP". This paper presents the results of our study of this matter and demonstrates the strong likelihood that progression of glaucoma almost certainly stops with "sufficient lowering of IOP".
Glaucoma surgery has entered a period of profound and rapid change. The diversity of surgical techniques and instruments has become a key feature of recent glaucoma surgery. Personal views on the place of surgery in the system of glaucoma management in the near future are discussed and strongly suggest that we are entering the era of minimally-invasive filtering surgery and the decline of MMC-Trab.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 155-170, 2018.

Key words
Glaucoma, Filtering surgery, Trabeculectomy, Mitomycin C, Antimetabolite, Intraocular pressure, Visual field, Normal tension glaucoma, Primary open angle glaucoma, Minimally-invasive glaucoma surgery
Reprint requests to
Tetsuya Yamamoto, M.D., Ph.D. Department of Ophthalmology, Gifu University Graduate School of Medicine. 1-1 Yanagido, Gifu-shi 501-1194, Japan